Lakoh S, Rickman H, Sesay M, et al. - Researchers examined adults with advanced HIV attending an urban tertiary hospital in Sierra Leone for the seroprevalence and mortality of the cryptococcal disease. Using a prospective cohort study design, they screened consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm³ from January to April 2018. A blood CrAg lateral flow assay (IMMY, Oklahoma, USA) was performed on all participants. Lumbar puncture and cerebrospinal fluid (CSF) CrAg assay were performed on participants with a positive serum CrAg, and fluconazole monotherapy was provided to those with cryptococcal diseases with 8 weeks followed up. They screened a total of 170 patients; median age was 36 (IQR 30–43) and median CD4 count was 45 cells/mm³ (IQR 23–63). Fifty-four percent were inpatients, 51% were recently diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days) at the time of enrolment. A positive blood CrAg was reported in eight participants, giving a prevalence of 4.7%. Outcomes thus suggest a substantial prevalence of cryptococcal antigenaemia. The cryptococcal disease was associated with poor outcome in this study. They observed high mortality suggesting a necessity for the HIV program to formulate and implement policies on screening and preemptive fluconazole therapy for all adults with advanced HIV in Sierra Leone and promote affordable access to effective antifungal therapies.